Managed Services-Bos-Ar Calling-Specialist

Line of Service

Advisory

Industry/Sector

Not Applicable

Specialism

Managed Services

Management Level

Specialist

Job Description & Summary

A career in our Managed Services team will provide you an opportunity to collaborate with a wide array of teams to help our clients implement and operate new capabilities, achieve operational efficiencies, and harness the power of technology.
Our Revenue Cycle Managed Services team will provide you with the opportunity to act as an extension of our healthcare clients' revenue cycle functions. We specialize in front, middle and back office revenue cycle functions for hospitals, medical groups, and other providers. We leverage our custom and automated workflow and quality assurance products to enable our clients to achieve better results, which ultimately allow them to provide better patient care.

To really stand out and make us fit for the future in a constantly changing world, each and every one of us at PwC needs to be a purpose-led and values-driven leader at every level. To help us achieve this we have the PwC Professional; our global leadership development framework. It gives us a single set of expectations across our lines, geographies and career paths, and provides transparency on the skills we need as individuals to be successful and progress in our careers, now and in the future.

As a Specialist, you'll work as part of a team of problem solvers, helping to solve complex business issues from strategy to execution. PwC Professional skills and responsibilities for this management level include but are not limited to:

• Conduct self in a professional manner and take responsibility for work and commitments.
• Flex approach to meet the changing needs of teams and clients.
• Identify and make suggestions for efficiencies and improvements when performing work.
• Take action to stay current with new and evolving technology.
• Use tools, techniques and firm standard methodologies to support research, analysis and problem solving.
• Handle, manipulate and analyse data and information responsibly.
• Communicate with empathy and adapt communication style to meet the needs of the situation and audience.
• Manage expectations of stakeholders effectively.
• Embrace different points of view and welcome opposing and conflicting ideas.
• Uphold the firm's code of ethics and business conduct.

Job Description Summary

1. Insurance Claim Follow-Up: Review and analyze unpaid or underpaid insurance claims. Contact insurance companies to identify reasons for denials, delays, or discrepancies in payments. Take necessary actions to resolve outstanding claims.

2. Claims Reconciliation: Verify that payments received from insurance companies match the expected reimbursement amounts. Investigate and reconcile any discrepancies.

3. Appeals and Resubmissions: Prepare and submit appeals for denied or underpaid claims, ensuring all required documentation is included. Monitor the progress of appeals and resubmissions.

4. Documentation and Reporting: Maintain detailed records of all interactions and actions taken regarding accounts receivable. Generate reports on AR aging, collection efforts, and outstanding balances.

5. Compliance: Ensure compliance with healthcare billing regulations and guidelines, including HIPAA and insurance industry standards.

6. Team Collaboration: Collaborate with billing and coding teams to resolve billing discrepancies and coding issues that may affect reimbursement.

7. Training and Development: Stay updated on healthcare industry billing and coding changes. Participate in training and professional development opportunities to enhance job knowledge and skills.

Qualifications:

• High school diploma or equivalent; some college coursework in healthcare administration or a related field is preferred.

• Knowledge of healthcare billing and coding procedures, including CPT and ICD-10 codes.

• Strong communication and negotiation skills, especially when dealing with insurance companies and patients.

• Attention to detail and the ability to analyze complex billing issues.

• Familiarity with healthcare billing software and electronic health record (EHR) systems.

• Proficiency in using office software, such as Microsoft Excel and Word.

• Understanding of healthcare compliance and privacy regulations, including HIPAA.

• Previous experience in healthcare revenue cycle management or medical billing is a plus.

• Ability to work well independently and as part of a team.

Experience Level : 1 to 3+ years

Professional and Educational Background :

Bachelor’s degree or higher in business related field, Healthcare Administration preferred; equivalent combination of education and/or work experience may be considered

Education (if blank, degree and/or field of study not specified)

Degrees/Field of Study required: Degrees/Field of Study preferred:

Certifications (if blank, certifications not specified)

Required Skills

Optional Skills

Desired Languages (If blank, desired languages not specified)

Travel Requirements

Not Specified

Available for Work Visa Sponsorship?

No

Government Clearance Required?

No

Job Posting End Date